2019-06-04_GENERAL DOCUMENTS - C1981022

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AC �® �-- CERTIFICATE OF LIABILITY INSURANCE DAT0(MM/D201) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services, Inc of Florida 1001 Brickell Bay Drive CONTACT NAME: jA/CNo Ext): (866) 283-7122 AIC.No.): (800) 363-0105 E-MAIL ADDRESS: Suite 1100 Miami FL 33131 USA INSURER(S) AFFORDING COVERAGE NAIC # POLICY PROVISIONS. INSURED INSURERA: Zurich American Ins c0 16535 Oxbow Enerqv solutions LLC INSURER B: American Guarantee & Liability Ins Co 26247 1601 Forum Place Suite 1400 INSURER C: ACE Property & Casualty Insurance Co. 20699 INSURER D: west Palm Beach FL 33401-8101 USA INSURER E: & condi INSURER F: DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence COVERAGES CERTIFICATE NUMBER: 570076444906 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY POLICY PROVISIONS. GLO Division of Minerals & Geology EACH OCCURRENCE $2,000,000 AUTHORIZED REPRESENTATIVE CLAIMS-MADEX❑ OCCUR 1313 Sherman street General Li abl i ty SIR applies per policy terns & condi l ons DAMAGE TO RENTED $1,000,000 PREMISES Ea occurrence MED EXP (Any one person) $10,000 CJS!/ sEul� PERSONAL &ADV INJURY $1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $4,000,000 POLICY ❑ PRO 7 LOC JECT PRODUCTS -COMP/OPAGG $2,000,000 OTHER A AUTOMOBILE LIABILITY BAP 9265950-09 Business Automobile Cover 06/01/2019 06/01/2020 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS X HIREDAUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per acadent B X UMBRELLA LIAB X OCCUR AUC926593709 06/01/2019 06/01/2020 EACH OCCURRENCE $25,000,000 EXCESS LIAB I CLAIMS -MADE umbrella AGGREGATE $25,000,000 DED I X RETENTION$10, 000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/ PARTNER / EXECUTIVE (Mandatory n NH) NIA JUN JUN 0 4 019E PEROTH- STATUTE I iER EL EACH ACCIDENT L DISEASE -EA EMPLOYEE If yes, descnbe under DESCRIPTION OF OPERATIONS below JEL DISEASE -POLICY LIMIT DIVISION OF REC AMATION MINING AND 8 1 IFETY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached rf more space is required) RE: Elk and Sanborn Creed Mines, Permit# C-1981-022. Commercial General Liability Coverage includes the use of explosives. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Division of Minerals & Geology AUTHORIZED REPRESENTATIVE 1313 Sherman street ItJ Room 215 Denver Co 80203 USA CJS!/ sEul� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD